Did you have a c-section and now wonder if the saying “once a c-section, always a c-section” is true? Do you want to have a large family but feel concerned that c-sections will prevent that dream? It’s natural to wonder how many c-sections you can have safely, thoughts that I had as well. 

After my second c-section, that very question filled my mind. I dreamed of having a large family, and while a personal friend of mine has had eight c-sections – yes, I’m serious – I wasn’t convinced that having multiple c-sections was the safest.

Over the years,

I’ve had all of the worries and thoughts that you might feel. Are you wondering how long you need to wait to get pregnant after a c-section or if you can try for a vaginal birth after a c-section?

After having four c-sections myself, I know exactly what you’re feeling, and I’m here to answer all of your questions. Who else can understand your worries better than a mother who has been right in your shoes? 

Let’s dive in together.

My First C-Section

My first c-section wasn’t planned and was far from the dream birth I imagined. After a failed induction due to the size of my baby, I faced a c-section. Ten years later, I now understand that the ACOG doesn’t recommend inducing due to the estimated size of a baby, but back then, I had no idea.

In the early hours on a cold January morning, I gave birth to my daughter, who weighs 9lbs 3oz. She is the smallest of my four kids, even though her weight makes her far from little. I held a baby girl with a head full of dark hair and dark eyes.

My c-section went off without a hitch. It wasn’t dreamy or what I hoped or planned for, but I had a healthy baby in my arms. I wasn’t happy about my c-section; I felt disappointed in myself. 

Did I try hard enough? Did I let my baby down by having a c-section and not pushing hard enough to have a successful vaginal birth?

All of my self-doubt and disappointed contributed to the postpartum depression that I developed. Thankfully, I noticed the signs and spoke to my doctor, and I received the help that was needed.

However, I knew that my husband and I wanted more kids, and that meant I had to either try for a VBAC or face a lifetime of c-sections. I didn’t know what sounded scarier, and I ended up with a lot of questions about having multiple c-sections.

Can I Have a Vaginal Birth After a C-Section?

Yes, you can have a vaginal birth after a c-section in most circumstances. I had to find a new OBGYN to perform a VBAC for me, but if you search for a supportive doctor, having a VBAC is a possibility for you. 60-80% of VBAC candidates will have a successful attempt! 

Currently, according to updated ACOG standards, you are considered a VBAC candidate if you meet these qualifications:

  • You have one previous cesarean delivery
  • You have a low-transverse incision 
  • The ACOG states that women with two previous low-transverse cesarean incisions are candidates
  • Women carrying twins can be appropriate candidates for a VBAC.

The Type of C-Section You Have Matters 

Something you might not realize is that the type of c-section you have matters, and doctors look for a low-transverse scar when mothers want to attempt a VBAC.

Here are the three types of c-sections.

Transverse

Transverse incisions are the safest choice and what your doctor wants to see if you desire a VBAC. This style of incision runs side to side on the lower part of your uterus. Once healed, your underwear covers the incision site.

Low-Vertical

A low vertical incision isn’t as safe as a transverse one. It’s still on the lower part of your uterus, but instead of running side to side, your doctor makes a vertical, up-and-down incision.

High-Vertical 

Years ago, this style of incision was the standard choice by doctors, but nowadays, evidence shows that it’s too risky to be used regularly. It’s typically reserved for emergency preterm deliveries. 

High-vertical incisions are made at the upper part of the uterus rather than the lower part, in a vertical direction. So, the incision runs up-and-down rather than side to side.

The Risks of Attempting a VBAC

While attempting a VBAC does have risks, it’s important to remember that having repeated c-sections has risks as well. Here are some risks that you should know.

  • Maternal hemorrhage
  • Infection
  • Blood clots
  • Hysterectomy
  • Uterine Rupture

The one concern that you might have is the risk of a uterine rupture during a VBAC. The risk of a uterine rupture during a trial of labor is low – between 0.7% and 0.9%. A uterine rupture is considered an emergency, potentially leading to injury to the mother or her baby.

When Can I Get Pregnant After a C-Section?

If you’ve had a c-section, it’s best not to get pregnant immediately after birth. Your body has a lot of healing to do, even if you look healed on the exterior. Your doctor will advise you to wait at least six weeks before resuming sexual intercourse.

That recommendation is two-fold. First, it helps to reduce the risk of infection. Your uterus has a large wound on the inside, and even if you can’t see it, it’s still there. You don’t want to introduce bacteria.

Second, you want to avoid getting pregnant before your body is ready. So, avoid sex until your doctor tells you that it’s safe to resume. 

Your doctor might also recommend that you wait six to 18 months after your last c-section to get pregnant again. The longer you wait to become pregnant, the lower the risk of any problems or complications. Your body will be better healed and prepared for another pregnancy and surgery.

Some doctors do advise waiting for the full 18 months to become pregnant again if you want to try for a VBAC. However, things don’t always work the way you want, and you might end up pregnant earlier. 

Babies don’t always listen to our plans, and if you fall pregnant before your planned time, talk to your doctor. The chances are good that you will have a healthy and happy pregnancy, even if you become pregnant before six months postpartum. 

My Second C-Section

Twenty-one months after I gave birth to my first child, I discovered I was pregnant with my second child. We were so excited, but I knew I wanted to attempt a VBAC. I knew I wanted to have more kids, and I wanted to try my hardest to avoid another c-section.

Unfortunately, after 28 hours of labor on July 4th, my doctor and I made a joint decision to opt for a c-section. Late that evening, I gave birth to a bald baby weighing 9lbs 13oz. He was even bigger than his sister! 

Unlike my first birth, I didn’t feel disappointed with myself. I knew that I tried my hardest, and the hospital I delivered in had different policies.

My child was never removed from me, so I breastfed immediately in recovery. He never left my side in the OR, and I watched him being weighed, the umbilical cord cut, and gave him plenty of kisses.

Now that I had two c-sections under my belt, I knew that the chances of me having a vaginal birth were unlikely, but I still had dreams of a larger family. My doctor knew my dreams, and I sat down with him at my six weeks postpartum examine with several questions.

Read my story: How I lost 30 pounds in less than 6 months!

The Potential Risks of Multiple C-Sections

It’s easy to forget that c-sections are a serious surgery. While it’s a form of giving birth, doctors never take this surgery lightly, and neither should you. If you have had more than one, you know that it takes time to recover from a c-section.

With each surgery, you face risks, and you need to know those risks. Here are some of those risks.

  • Heavy Bleeding
  • Infections
  • Bladder Injuries
  • Bowel Injuries
  • Excessive Scar Tissue Formation
  • Blood Clots
  • Hysterectomy
  • Blood Transfusion 

Something else that you should know is that excessive bleeding does increase with each c-section. By your third c-section, excessive bleeding goes up to 7.9%. While, in most cases, the doctor and staff stop the bleeding fast, some moms do require a blood transfusion, but extreme cases might require a hysterectomy.

Speaking of hysterectomy, the risk of having one increases with each additional c-section. You have a 1% chance for your first three c-section and a 2.4% risk on the fourth c-section. Then, it goes up to 3.5% for the fifth and 9% on the six c-section.

How Many C-Sections Can You Have Safely?

Each doctor that you ask this question will have a different answer because there is no magical number of safe c-sections that you can have.

Here’s the deal.

Every woman is unique. Some women, such as my friend, can have 6+ c-sections with little problems or complications. Then, you can have a woman with a second cesarean who experiences many adhesions and complications.

Everyone heals differently, and that’s why you need to have this candid conversation with your doctor. I asked my doctor after each c-section if it was safe to pursue another child. No one can answer this question better than the doctor who performed your surgeries.

Due to the complexity of this question, most doctors won’t give a woman a limit on how many c-sections she can have. They do all have their policies. For my doctor, she refers her patients who had five c-sections out to a high-risk maternal doctor to ensure nothing is missed. 

pregnant woman with gynecology

Doctors do all agree that certain risks increase as the number of repeat cesarean sections increases. You have a higher risk of needing a blood transfusion, injury to your bladder or needing a hysterectomy at the time of delivery.

Each of these risks increases to around 1% once you have had three c-sections. Your risk of needing a hysterectomy increases to almost 9% after your sixth surgery!

My Third C-Section

By the time I had my third c-section, I felt like an old pro. I knew what to expect, but what I didn’t realize is that having a planned repeat c-section is much more relaxed and less stressful than an unexpected one.

My third birth was nothing short of a dream birth. I watched the birth of my child, had skin to skin in the OR, and my son never left my side. Weighing 10lbs7oz (yes, you read that right), he was a tall, skinny baby despite his weight because he measured 23 inches long.

I have to tell you that having a gentle c-section changes your birthing experience. The atmosphere was so relaxed. We played music, the staff laughed and joked with us, and our baby arrived in a room full of peace. 

During my c-section, I remember asking my doctor, “is it safe for me to have another c-section?” He paused, looked at my incision, and said, “you have a bit of thinning on the left side of your uterus, but it is nothing abnormal. You’d be safe to have another one.”

I sighed a huge ball of the stress out; our dream of a larger family could come true after all. While my dream birth left me buzzing with postpartum hormones and dreamy memories, I still had concerns about recovering from a third c-section and what I could face during a fourth. 

Spinal vs. General Anesthesia

This might seem like a weird worry, but I managed to escape general anesthesia for all three of my c-sections. So, I was concerned with needing it for my fourth c-section. Knowing that my body typically doesn’t handle general anesthesia well and leads to trouble with my blood pressure, I wanted to avoid it. So, I spoke to my doctor about my concerns.

Here is what I learned.

The American Society of Anesthesiologists (ASA) prefers to use spinal blocks or an epidural during c-section deliveries because it exposes your baby to the lowes amount of medication. Also, it allows the mother to participate in her baby’s birth still actively. 

General anesthesia is only used in some cases. It does cause you to lose consciousness so that you won’t be awake for the birth of your baby. That’s why most anesthesiologists avoid using this unless necessary during an emergency. 

What Are Possible Health Risks You Face with Multiple C-Sections?

Most of the health risks you face come during or directly after you have a c-section. Some of these risks might extend into the months and years after your surgery. 

Here are some that you might want to know.

  • After the third c-section, you have a higher than a 1% risk of a bladder injury. This risk increases because of adhesions, which are scar-like tissue that connects your bladder to your uterus. 
  • Adhesions can also cause small bowel obstructions.
  • You might have short or long-term numbness near and around your incision site. 
  • Mothers might have urinary incontinence and pelvic organ prolapse. 
  • You might have the chronic nerve or muscle pain, triggered by the trauma of surgery. 

Can Multiple C-Sections Cause Fertility Issues?

Some evidence shows that c-sections can have effects on your fertility. We know that women who have had previous cesarean births have a higher risk of having a miscarriage or a stillbirth in future pregnancies.

Also,

The studies show that placental problems increase with future pregnancies if you’ve had a c-section rather than a vaginal delivery. Some studies indicate that secondary infertility after a c-section might be due to medical causes. It might take longer to conceive future children due to pelvic adhesions, infection, or placental bed disruptions.

Another fertility risk is an increased risk of ectopic pregnancies. Evidence shows that c-section moms have a 9% risk of having a future ectopic pregnancy than mothers who deliver vaginally. 

While rare, some women report endometriosis after a c-section. It happens when the endometrial tissue begins to grow in the incision site after a c-section. Doctors say only 1.6% of women report this problem; it’s also possible that women don’t connect the issues with their c-sections. 

My Fourth C-Section

In March 2018, I had my fourth c-section and delivered my last baby, a little girl weighing 9lbs 15oz. Her birth, while beautiful and full of skin-to-skin and lots of kisses, showed me the scary reality that can face mothers who have multiple c-sections. 

As soon as my doctor began the surgery, I knew things were different. The room went quiet, and she let me know that my uterus was close to rupturing, even though I was not in labor. My uterus was so paper-thin that she barely had to cut it to reach my daughter.

We dodged a bullet. I never went into labor, but if I had, chances were high that my uterus would have ruptured.

This is interesting:

My daughter arrived screaming and healthy, despite discovering meconium in the womb. I breastfed my daughter in the OR, and we had ample skin-to-skin time in the first several hours after her birth.

While my husband and I decided that having any more children was too dangerous, that might not be the situation for you. Here are a few more things I had in my mind about having multiple c-sections. 

The Increased Risk of Placenta Accreta 

When I was pregnant with my fourth child, I did a lot of reading to figure out the risks we would face during pregnancy and my fourth c-section. 

One significant risk you face when you have multiple c-sections is placenta accreta. You might have never heard of this before, but it is a danger that you need to understand. 

Placenta accreta happens when your placenta ends up implanted near your previous c-section scar instead of behind your baby or anywhere away from the scar. If your doctor fails to diagnose this problem, bleeding to death during delivery is a possibility, but the most significant risk is a possible hysterectomy.

Years ago, the risk of dying because of placenta accreta was a scary 50%. Nowadays, the rate of death due to this is dramatically lower.

If you’ve had a c-section, then you have an increased risk of placenta accreta. With each additional c-section that you have, your chance of placenta accreta increases, especially if you also have placenta previa. That is when the placenta covers the opening of your cervix. 

Here’s the real risk if you have placenta previa as well according to the ACOG:

  • Women with no prior c-sections and diagnosed placenta previa – 3%
  • First c-section – 3%
  • Second c-section – 11%
  • Third c-section – 40%
  • Fourth c-section – 61%
  • Fifth C-Section – 67%

Placenta accreta can be detected if your doctor orders an ultrasound to determine the location of your placenta. Because of my concerns, I spoke to my OBGYN, and she ordered an ultrasound to find the location. 

Your Scar Can Cause Future Issues

Whether you’re done having babies or not, your scar can cause future problems, and not enough doctors discuss this issue.

When you have a c-section, layers of scar tissue develop afterward, and with each following c-section, the tissue continues to compound. That’s why each surgery can take longer. Cutting through the scar tissue can take time.

All of the scarrings can lead to uterine scar dehiscence. Over time this scar tissue becomes thin and starts to tear. Since this is part of your uterine walls, it could cause complications, such as infertility. In rare cases, it can even lead to death. 

Typically, the presentation of uterine scar dehiscence isn’t apparent, but it can cause some signs, such as:

  • Secondary infertility
  • Chronic pelvic pain
  • Dysmenorrhea
  • Intermenstrual bleeding
  • Irregular genital bleeding
  • Dyspareunia

Thankfully, we know that this isn’t common. Most women have no scar problems after delivery, but women should always be made aware of the possible risks. 

Your C-Section Might Cause Additional Surgeries Later

No matter if you had one or five c-sections, you always have a risk of needing additional surgeries from complications. The most common reason why you would need an operation after a c-section would be due to the number of adhesions on your uterus. 

Not only do adhesions make it harder for OBGYNs to perform each c-section and increase the length of time for each surgery, but adhesions also form organs stick together. These adhesions attach to other organs, so during a c-section, an organ might get cut. 

How does this lead to more operations?

Depending on the severity of the adhesions, you might need additional surgery to remove the adhesions from the surrounding organs. You might need to have bowel or bladder surgery or a hysterectomy. 

Should You Have Multiple C-Sections?

For the most part, doctors agree that women can have three to four c-sections, but women need to be aware of the risks that come with these surgeries. Each surgery comes with an increased risk, and you must be comfortable taking those risks to grow your family. 

If you have questions or concerns, your OBGYN should be able to calm your fears. You can always seek a high-risk fetal medicine doctor to help ensure nothing goes without a hitch during your pregnancy and childbirth. Having multiple c-sections shouldn’t stop you from having the family size that you desire.

Author

Hey, this is Linda. My biggest accomplishment in life is being a mother of four children. Their current ages range from almost ten years old down to 20 months old. I'm passionate about writing parenting articles because I understand so well all of the problems and trials you face as a parent. From breastfeeding woes to budgeting problems and behavior problems, along with everything in between, chances are I've faced it over the last ten years.

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